Juggling conflicting demands: registered nurses' experiences of goal conflicts in acute illness consultations in primary care - a thematic analysis.

Abstract

Primary care includes preventive and acute care, and management of long-term conditions. In Sweden, approximately 40 million annual visits are made to primary care, of which more than 12 million are registered nurse consultations. Registered nurses are often responsible for initial assessments, including triage and prioritization. Timely and accurate assessments are essential, as inappropriate decisions may adversely affect both care quality and patient outcomes. However, demographic changes, rising chronic disease prevalence, and growing expectations for accessible and efficient services continue to strain primary care capacity. Therefore, this study aims to explore registered nurses' experiences of goal conflicts in decision-making during primary care consultations for acute illnesses, with a focus on clinical assessment, prioritization, and their perceived consequences. A qualitative study using semi-structured focus group discussions was conducted to explore registered nurses' experiences and perspectives. Seven focus group discussions with 27 registered nurses in Sweden were conducted between April and May 2025. A thematic analysis was conducted. The results present one overarching theme, Juggling conflicting demands of optimal and timely care with limited resources, and four interrelated themes illustrating these goal conflicts: organizational demands versus quality of care, accessibility versus risk of crowding out, expectations versus adequate resources, and teamwork versus professional autonomy. The findings highlight conflicting organizational, professional, and patient-driven goals that result in ethical dilemmas and ambivalence among registered nurses. This study indicates that goal conflicts in primary care arise from extensive assessment responsibilities placed on registered nurses without adequate alignment with education, competence, and organizational support. Despite extensive responsibilities for clinical assessment, decision-making, and prioritization, registered nurses have limited influence over organizational conditions, creating an asymmetry between responsibility and authority. These findings suggest a need for improved alignment between roles, competence, and organizational support.